EMPLOYEE PERFORMANCE APPRAISAL FORM EPA-3 …

1 EMPLOYEE PERFORMANCE APPRAISAL form EPA-3 INSTRUCTIONS This form is in a fillable PDF format. Type in the text boxes (use additional pages if more space is needed and indicate such in the appropriate text box); use the space key or mouse to add/delete checkmarks where appropriate. PREPARATION Schedule an interview with each EMPLOYEE . Provide each EMPLOYEE with a copy of this form for self evaluation. o NOTE: Self evaluation should be encouraged but not required. Complete this form prior to interview, commenting briefly on all PERFORMANCE elements. Those elements checked Needs Improvement or Exceeds Expectations require comment. o NOTE: Comments, negative or positive, should come as no surprise to the EMPLOYEE . Review the completed form with your manager prior to the EMPLOYEE interview.

2 INTERVIEW Meet with EMPLOYEE privately and without interruption. Review EMPLOYEE s functional job description together with expectations and standards established and communicated at beginning of PERFORMANCE period. Discuss completed APPRAISAL form (s), allowing for EMPLOYEE input. Encourage EMPLOYEE to make written comments on completed form . Sign the form in EMPLOYEE s presence and secure his/her signature. COMPLETING THE form If you use a word processor (PC) to complete this form , print a blank copy before you begin. This will ensure that your printer will print the form properly. Word processor font differences may affect the appearance of the form . With the Rating Category Key as your guide, clearly check (9) the appropriate box for each element. Remember that these are behavioral elements and that your judgment in each case must be supported by fact.

3 There are 23 PERFORMANCE elements for all employees and an additional 14 for supervisors and managers. o All 37 PERFORMANCE elements are stated at the success level and are to be considered the standard for Meets Expectations. Summarize the data on the Rating Score Sheet. RATING CATEGORY KEY FOR DOP form EPA 3 Exceeds Expectations This overall evaluation demonstrates job PERFORMANCE at a level exceeding that of a satisfactory evaluation. The EMPLOYEE s PERFORMANCE regularly surpasses the standards expected. Meets Expectations This overall evaluation demonstrates success and competency in the PERFORMANCE of the job. The EMPLOYEE has produced the desired or intended results and completely satisfies the established standards and expectations. Needs Improvement This indicates an overall PERFORMANCE that is unacceptable due to the EMPLOYEE s own lack of effort or skills.

4 The EMPLOYEE has not met the standards as expected and must take immediate corrective action. NOTE: You will clearly check (9) one of these three levels for each PERFORMANCE element (23 for all employees and an additional 14 for supervisors and managers). When you do so, you are comparing the EMPLOYEE s actual PERFORMANCE to the standards and expectations established at the beginning of the PERFORMANCE period. February 15, 2013 EMPLOYEE PERFORMANCE APPRAISAL form EPA-3 Use this form for the final review of the PERFORMANCE period. See instructions on the previous page. EMPLOYEE INFORMATION EMPLOYEE Name: Social Security Number: (last 4 digits to be completed by the EMPLOYEE ) Position Title: Supervisor s Name and Title: Department: Agency: Division (and Section): Rating Period: to Type of Rating Time in Present Position (in months) Annual Probationary Special RESPONSIBILITIES: Essential duties and responsibilities as identified in the functional job description.

5 PERFORMANCE STANDARDS and EXPECTATIONS: Objectives to be accomplished during this rating period. ACKNOWLEDGEMENT: A discussion of duties, responsibilities, PERFORMANCE standards, and expectations for the current period took place on _____ (date from EPA-1 form ). We acknowledge our understanding of these items and how they will be used to measure work-related PERFORMANCE during this period. _____ _____ Supervisor s Signature Date EMPLOYEE s Signature Date February 15, 2013 West Virginia Division of Personnel February 15, 2013 form EPA-3 Page 2 of 6 PERFORMANCE FACTORS and STANDARDS Check the rating for each appropriate category NEEDS IMPROVEMENT MEETS EXPECTATIONS EXCEEDS EXPECTATIONS MAINTAINS FLEXIBILITY Willingly accepts a variety of responsibilities Adapts to new situations in a positive manner Displays openness to learning and applying new skills Works well with others to achieve organization s goals.

6 Is resourceful and generally seeks work process improvements COMMENTS: DEMONSTRATES CREDIBILITY Shares information with others when appropriate Acts independently while keeping supervisor informed Performs work according to current guidelines and directives Maintains personal appearance appropriate to job Exhibits ability to secure and evaluate facts before taking action COMMENTS: CUSTOMER SERVICE Treats all customers with respect Responds to customers needs within appropriate timeframes Addresses conflicts and problem situations with patience and tact COMMENTS: West Virginia Division of Personnel February 15, 2013 form EPA-3 Page 3 of 6 PERFORMANCE FACTORS and STANDARDS Check the rating for each appropriate category NEEDS IMPROVEMENT MEETS EXPECTATIONS EXCEEDS EXPECTATIONS QUANTITY OF WORK Work output matches expectations established EMPLOYEE completes all assignments EMPLOYEE consistently meets deadlines COMMENTS: QUALITY OF WORK Work results satisfy organization s goals Work is organized and presented professionally Work product is thorough and complete Work product is free of flaws and errors COMMENTS: AVAILABILITY FOR WORK EMPLOYEE s attendance supports the expected level of work EMPLOYEE s presence can be relied upon for planning purposes EMPLOYEE is a dependable team member COMMENTS.

7 Proceed to Page 4 to continue rating if EMPLOYEE is also a supervisor or manager; proceed to Page 5 if EMPLOYEE is not a supervisor or manager. West Virginia Division of Personnel February 15, 2013 form EPA-3 Page 4 of 6 THIS PAGE IS FOR RATING SUPERVISORS AND MANAGERS ONLY: In addition to the 23 PERFORMANCE elements for all employees, supervisors and managers shall be rated on the following critical success factors: Leadership, Management, and Work Environment. Check the appropriate box for each of the 14 PERFORMANCE elements. PERFORMANCE FACTORS and STANDARDS Check the rating for each appropriate category NEEDS IMPROVEMENT MEETS EXPECTATIONS EXCEEDS EXPECTATIONS LEADERSHIP Provides clear direction and purpose Models ethical workplace behavior Demonstrates influencing skills by setting goals Empowers subordinates to achieve objectives Acts to motivate, coach, and develop subordinates COMMENTS: MANAGEMENT Organizes and distributes work among subordinates Secures resources and audits their effective use Communicates behavioral expectations and PERFORMANCE standards Monitors, documents, and evaluates EMPLOYEE conduct and PERFORMANCE Provides appropriate and timely feedback COMMENTS.

8 WORK ENVIRONMENT Maintains a safe and healthy workplace Builds a team that reflects high morale, clear focus, and group identity Encourages and provides opportunities for subordinates to obtain and apply new skills and knowledge Promotes equal opportunity and protects the rights of all employees COMMENTS: West Virginia Division of Personnel February 15, 2013 form EPA-3 Page 5 of 6 RATING SCORE SHEET FOR DOP form EPA-3 Enter the total number of checks in each rating category, then multiply by the assigned value. RATING CATEGORIES COUNT MULTIPLIER CATEGORY TOTALS Exceeds Expectations X 3 = Meets Expectations X 2 = Needs Improvement X 1 = TOTAL ELEMENTS RATED TOTAL VALUE = To compute the rating score, divide the total value by the total number of elements rated* to find the overall rating score.

9 Make certain to carry out your calculation to two decimal places. EXAMPLE: 44 23 = *37 for a supervisor or manager; 23 for a non-supervisory/non-managerial EMPLOYEE RATING SCORE TOTAL VALUE TOTAL ELEMENTS = Once the rating score is determined, enter it below as the Overall Rating Score. Find the corresponding alpha score on the key below and enter it in the Alpha Score column. KEY numeric SCORE ALPHA SCORE Rating of to Needs Improvement Rating of to Meets Expectations Rating of to Exceeds Expectations SUMMARY OVERALL SCORE ALPHA SCORE SUMMARY COMMENTS (to be completed by the supervisor or rater) IMPROVEMENT and/or DEVELOPMENT PLAN (to be completed by the supervisor or rater) REVIEWING MANAGER S INITIALS DATE West Virginia Division of Personnel February 15, 2013 form EPA-3 Page 6 of 6 EMPLOYEE RESPONSE (to be completed by the EMPLOYEE ) EMPLOYEE CERTIFICATION I certify that I have reviewed this PERFORMANCE APPRAISAL form .

10 My signature below implies my acknowledgement of this review, and does not imply my agreement or my disagreement with the form s contents. _____ _____ Supervisor s Signature Date _____ _____ EMPLOYEE s Signature Date _____ _____ Reviewing Manager s Signature Date